Endocrine Abstracts

Today diabetes (DM) is one of the largest global health emergencies. Each year a large number people live with this condition. Currently there are more than 422 mln people with DM worldwide. DM is one of the major public health problems in Georgia. Number of people with DM is on the rise, though no exact statistical data for Georgia exist. Diabetes Atlas (International Diabetes Federation, 2015) gives diabetes prevalence for Georgia of 7.9%, though these data are extrapolated from other countries. On the other hand, hypothyroidism (HOT) is believed to be a common health issue worldwide. The prevalence of HOT in the developed world is about 4–5%, and the prevalence of subclinical HOT is about 4–15%. Both HOT and subclinical HOT are thought to be risk factors for T2DM development. In our patients approximately 30% of women and 15% of men have both conditions. Prevalence of both conditions increases with the age of the patients (age 35–74 years, prevalence range 7–5%).

Materials and methods: Herein, 2 clinical cases (coexisting T2DM and HOT) are discussed. Both patients (pt) were diagnosed and are managed at the National Centre for Diabetes Research. Case #1 – pt. E.G., 49 years old, female. T2DM since 2008, HOT – since 2015. Pt. was treated with oral hypoglycaemic agents (OHAs) – SU and Metformin (Met), in 2017 pt. was transferred to DPP-4 and Met. DM control is satisfactory. In 2015 pt addressed the Centre with typical signs and symptoms – weight gain, dyspeptic symptoms, cognitive impairment, constipation. Ultra-sound examination was performed and thyroid hormones (TSH, F₄, anti-TPO) were tested. L-thyroxine therapy was initiated (50 mg, then elevated to 100 mg). Since treatment initiation pt. condition is satisfactory, clinical and laboratory tests have improved. Pt is control every 3 months. Prescribed treatment is continued, Case # – pt. K.N., 65 years old, female, HOT and goiter with thyroid nodules (no biopsy performed) were diagnosed in 2010. Treatment with L-thyroxine was initiated. No follow-up was carried out though the drug (50 mg) was used regularly. In 2017 pt. came to our Centre for the 1-st time. Ultrasound of the thyroid gland and hormone tests was performed that revealed thyroid nodules (TSH was within the n range). Nodule biopsy was carried out, colloid goiter was diagnosed. Pt had following DM risk factors – family history of DM, obesity, arterial hypertension, HOT. Thus, she was screened for DM. HbA1c was 7.0% indicating to T2DM. Met. (500 mg) was initiate. Treatment with L-thyroxine at selected dose is continued. Diet and physical activity recommendations were selected individually. At present both pts are regularly followed-up (every 3 months). Doses and treatment are adjusted based on the results achieved.

Conclusion: Combination of the conditions is globally widely spread, it needs serious attention, knowledge and experience to manage. Proper management permits pts to live long and productive life and avoid complications caused by the conditions.